St. John’s Wort, the Anti-Depressant Herb – The Natural Prozac
If you are depressed, a pill made from the plant St. John’s wort may boost your mood. St. John’s wort, also called hypericum, is now widely accepted by doctors in this country for relieving mild to moderate depression after having been used successfully for decades in Europe, notably Germany. There is no question it works, says Norman Rosenthal, M.D., senior research psychiatrist at the National Institute of Mental Health and author of the book St. John’s Wort: The Herbal Way to Feeling Good. In fact, many doctors now see St. John’s wort as the first “drug” to try before conventional prescription antidepressants, such as Prozac and Zoloft. Such strong pharmaceutical drugs often have serious side effects, in contrast with St. John’s wort which has only minimal adverse effects.
Worldwide, St. John’s wort is the most commonly used antidepressant. More than seven million Americans now take it.
St. John’s wort has proved to be an effective antidepressant in numerous double-blind studies in Europe. One analysis of many studies showed that St. John’s wort relieved symptoms of mild to moderate depression partially or totally in 80 percent of about 3250 patients. It can work as well or better than prescription drugs, or in some cases along with prescription drugs.
The evidence for St. John’s wort is so impressive that the National Institutes of Health has launched a major two-year study of effectiveness of the herb in treating mild to moderate depression at twelve U.S. medical centers, coordinated by Duke University. The brand used in the study: an extensively tested German product made by Lichtwer Pharma (LI160 or Jarsin) and sold under the name Kira in the United States. It is available over the counter without prescription.
Here are the types of depression that call for trying St. John’s wort, according to Dr. Rosenthal: mild depression; short-term stress associated with depression and anxiety; moderate depression; depression in those who are very sensitive to, or concerned about, side effects; winter depression (seasonal affective disorder, or SAD); depression in the elderly; dysthymia (chronic low grade unhappiness).
New research shows that St. John’s wort is especially good in treating the “winter blues,” known as seasonal affective disorder (SAD) that comes with the dark days of winter. British investigators compared St. John’s wort with light box therapy, which is known to be very successful in relieving SAD. St. John’s wort was virtually as effective as light therapy after eight weeks. Among 301 Britons suffering from SAD, half were randomized to use the light box, the other half got St. John’s wort. The severity of SAD symptoms, including depression, sleep disturbance, and lethargy, decreased 39 percent in those taking St. John’s wort and 43 percent in those using the light box therapy, which was not a significant difference, said researchers. Of course, taking a pill is less hassle than using a light box, they pointed out.
It is not totally clear how St. John’s wort relieves depression. Initially, researchers believed it worked the same way as so-called selective serotonin reuptake inhibitors (SSRIs) that include Prozac. The herb’s main ingredient, hypericin, supposedly manipulated the neurotransmitter serotonin which helps govern mood. But now experts think St. John’s wort affects other neurotransmitters as well, and other chemicals in the remedy also appear active. Most likely, many ingredients in St. John’s wort work together for a total benefit unlike that found in synthetic antidepressants.
Recommended dose: a daily total of 900 milligrams taken in doses of 300 milligrams three times a day. Although some people may get relief with one or two tablets, others require more than three tablets.
Depression may lift within a few days of starting St. John’s wort, or the full effect may take six weeks. Generally, however, you should see some improvement after three weeks of taking 900 milligrams daily, says Dr. Rosenthal. If you don’t, you may want to increase the dose, or consider a conventional antidepressant in lieu of or in addition to St. John’s wort. Be sure to consult a doctor.
Potential side effects: Most common are minor side effects such as gastrointestinal irritation, nausea, indigestion, abdominal pains. Studies show such side effects to be very low—about 21/2 percent. Exposure to sunlight if taking St. John’s wort could be hazardous. One woman on St. John’s wort experienced temporary nerve damage causing painful sensitivity in areas of the body exposed to the sun, according to a recent report in the medical journal Lancet. Symptoms disappeared after the woman stopped taking the herb.
Restrict alcohol to no more than a glass or two of beer or wine or one mixed drink when you are taking St. John’s wort.
Cautions: Don’t substitute St. John’s wort for prescription antidepressants without first consulting your doctor. Don’t take St. John’s wort along with prescription antidepressants; the two could produce a hazardous interaction. Do not self-diagnose depression: Your symptoms could come from another medical cause; see a health professional. Don’t take St. John’s wort if you are pregnant. If you have bipolar, manic depression, use St. John’s wort only under the close supervision of a doctor. It may or may not work.
Further, St. John’s wort is designed to treat people with clinical signs of mild to moderate depression, and does not work as a casual “upper” for people who are just temporarily feeling down. Nor is there convincing evidence that it relieves severe depression.
Consumer advice: Some laboratory analyses of St. John’s wort have found exceptionally low levels of the reputed active ingredient in some brands. One test in 1999 detected only 5 percent of the amount of active ingredient claimed on the label of one product. Varro Tyler, dean emeritus of Purdue University’s School of Pharmacy and a leading authority on herbal remedies, advises always buying St. John’s wort that is “standardized” to contain .3 percent of hypericin. Even then you can’t be sure.
Your most reliable bet: Kira, which is the brand used in many studies, including the new one sponsored by the National Institutes of Health.